Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry

Area of Science:

• Psychiatry
• Clinical Psychology
• Medical Ethics

Background:

• Patient competence, crucial for informed consent, is seldom explored in obsessive-compulsive disorder (OCD).
• Dilemmas arise between respecting patient autonomy and beneficence when OCD patients refuse treatment.
• A nuanced understanding of competence is needed, reflecting clinical realities and patient experiences.

Observation:

• A naturalistic case study examined patient competence in a medical student with OCD.
• In-depth interviews and narrative analysis provided both patient and therapist perspectives.
• Competence emerged as a co-constructed reality, not solely a clinician's assessment.

Findings:

• The patient's narrative evolved from a restitution (rationality-focused) to a quest (emotions, values-focused) style.
• The therapist utilized motivational interventions, emphasizing patient responsibility.
• Both patient and therapist engaged in a quest narrative, viewing competence as practical reasoning incorporating values and emotions.

Implications:

• This study reframes competence in OCD as a dynamic, collaborative process.
• It highlights the importance of narrative in understanding and assessing patient decision-making capacity.
• Clinical practice should embrace narrative approaches to better support treatment adherence and ethical care in OCD.